Understanding Depression

Gain a better understanding of depression by learning more about:

Types of Depression
Hallmarks of Depression
Signs and Symptoms
Causes and Contributing Factors

Types of depression include:

Major depression
This type of mood disturbance lasts more than two weeks. Symptoms may include overwhelming feelings of sadness and grief, loss of interest or pleasure in activities you usually enjoy, and feelings of worthlessness or guilt. This type of depression may result in poor sleep, a change in appetite, severe fatigue and difficulty concentrating. Severe depression may increase the risk of suicide.

Dysthymia (dis-THI-me-uh) is a less severe but more chronic form of depression. Signs and symptoms usually aren’t disabling, and periods of dysthymia can alternate with short periods of feeling normal. Having dysthymia places you at an increased risk of major depression.

Adjustment disorders
If a loved one dies, you lose your job or you receive a diagnosis of cancer, it’s perfectly normal to feel tense, sad, overwhelmed or angry. Eventually, most people come to terms with the lasting consequences of life stresses, but some don’t. This is what’s known as an adjustment disorder – when your response to a stressful event or situation causes signs and symptoms of depression. Some people develop an adjustment disorder in response to a single event. In others, it stems from a combination of stressors. Adjustment disorders can be acute (lasting less than six months) or chronic (lasting longer). Doctors classify adjustment disorders based on the primary signs and symptoms of depression or anxiety.

Bipolar disorder
Having recurrent episodes of depression and elation (mania) is characteristic of bipolar disorder. Because this condition involves emotions at both extremes (poles), it’s called bipolar disorder or manic-depressive disorder. Mania affects your judgment, causing you to make unwise decisions. Some people have bursts of increased creativity and productivity during the manic phase. The number of episodes at either extreme may not be equal. Some people may have several episodes of depression before having another manic phase, or vice versa.

Seasonal affective disorder. Seasonal affective disorder (SAD) is a pattern of depression related to changes in seasons and a lack of exposure to sunlight. It may cause headaches, irritability and a low energy level.

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Hallmarks of Depression

Two hallmarks of depression – symptoms key to establishing a diagnosis – are:

Loss of interest in normal daily activities
You lose interest in or pleasure from activities that you used to enjoy.

Depressed mood
You feel sad, helpless or hopeless, and may have crying spells.

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Signs and Symptoms

In addition, for a doctor or other health professional to diagnose depression, most of the following signs and symptoms also must be present for at least two weeks.

Sleep disturbances
Sleeping too much or having problems sleeping can be a sign you’re depressed. Waking in the middle of the night or early in the morning and not being able to get back to sleep are typical.

Impaired thinking or concentration
You may have trouble concentrating or making decisions and have problems with memory.

Changes in weight
An increased or reduced appetite and unexplained weight gain or loss may indicate depression.

You may seem restless, agitated, irritable and easily annoyed.

Fatigue or slowing of body movements
You feel weariness and lack of energy nearly every day. You may feel as tired in the morning as you did when you went to bed the night before. You may feel like you’re doing everything in slow motion, or you may speak in a slow, monotonous tone.

Low self-esteem
You feel worthless and have excessive guilt.

Less interest in sex
If you were sexually active before developing depression, you may notice a dramatic decrease in your level of interest in having sexual relations.

Thoughts of death
You have a persistent negative view of yourself, your situation and the future. You may have thoughts of death, dying or suicide.

Depression can also cause a wide variety of physical complaints, such as gastrointestinal problems (indigestion, constipation or diarrhea), headache and backache. Many people with depression also have symptoms of anxiety.

Children, teens and older adults may react differently to depression. In these groups, symptoms may take different forms or may be masked by other conditions. Kids may pretend to be sick, worry that a parent is going to die, perform poorly in school, refuse to go to school, or exhibit behavioral problems. Older people may be more willing to discuss the physical manifestations of depression, instead of their emotional difficulties.

There’s no single known cause for depression. The illness often runs in families. Experts believe a genetic vulnerability combined with environmental factors, such as stress or physical illness, may trigger an imbalance in brain chemicals called neurotransmitters, resulting in depression. Imbalances in three neurotransmitters – serotonin, norepinephrine and dopamine – seem to be linked to depression.

Scientists don’t fully understand how imbalances in neurotransmitters cause signs and symptoms of depression. It’s not certain whether changes in neurotransmitters are a cause or a result of depression.

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Factors that contribute to depression include:

Researchers have identified several genes that may be involved in bipolar disorder, and they’re looking for genes linked to other types of depression. But not everyone with a family history of depression develops the disorder, and conversely, people with no family history of the disorder can become depressed.

Stressful life events, particularly a loss or threatened loss of a loved one or a job, can trigger depression.

Long-term use of certain medications, such as some drugs used to control high blood pressure, sleeping pills or, occasionally, birth control pills, may cause symptoms of depression in some people.

Having a chronic illness, such as heart disease, stroke, diabetes, cancer or Alzheimer’s disease, puts you at higher risk of developing depression. Having an underactive thyroid (hypothyroidism), even mildly, also can cause depression.

Certain personality traits, such as having low self-esteem and being overly dependent, self-critical, pessimistic and easily overwhelmed by stress, can make you more vulnerable to depression.

Postpartum depression.
It’s common for mothers to feel a mild form of distress that usually occurs a few days to weeks after giving birth. During this time you may have feelings of sadness, anger, anxiety, irritability and incompetence. A more severe form of the baby blues, called postpartum depression, also can affect new mothers.

Women experience depression about twice as much as men, which leads researchers to believe hormonal factors may play a role in the development of depression.

Alcohol, nicotine and drug abuse.
Experts once thought that people with depression used alcohol, nicotine and mood-altering drugs as a way to ease depression. But using these substances may actually contribute to depression and anxiety disorders.

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